A Historical Perspective of the Korean Society of Medical Education / 한국의학교육

No abstract available.

Actual Status of Constipation and Life Factors Affecting Constipation by Diagnosis of Rome in Female University Students in Korea

This study investigated the actual status of constipation. In total, 978 female students in Korea participated. We identified the relationship among constipation and life style, clothing patterns, housing patterns, dietary habits, and dietary intake in a constipation symptom group and a normal group. The actual constipation rate based on the Rome II criteria was 27.0% (n = 264). Body weight (p < 0.05) and body mass index (p < 0.05) in the constipation group were significantly higher than those in the normal group. The incidence of functional bowel disease and irritable bowel syndrome in the constipation group were significantly higher than those in the normal group. The discomfort of wearing underwear was significantly higher in the constipation group than that in the normal group. The constipation group revealed a significantly higher rate of irregular dietary habits than those in the normal group. The dietary diversity score of the normal group was 4.22 (p < 0.05), which was significantly higher than that of constipation group (4.12). No significant difference in life style factors was observed. It is necessary for university female students to correct their dietary habits, maintain food intake of three times per day, and select diverse foods. Furthermore, it is necessary for university female students to wear comfortable clothing to lessen symptoms and improve constipation rates.

The Way of Making a Good Doctor / 한국의학교육

No abstract available.

Improved Medical Terminologies as Foundation for Good Practice

A harmonious relationship between doctors and their patients establishes a firm foundation for good practice. Factors that affect such a relationship include communication skills and the language used. Essentially, the language should be clear and comprehensible for both parties. Doctors usually tend to use technical jargons. Since Korean doctors were educated with English textbooks, they are inclined to teach their students in English terms. Their use of old medical terms makes communication with their patients very difficult. Such language impediment complicates matters when doctors have to answer the patients' questions and ask detailed questions about their condition. And it is not only in the use of English where communication problems arise between doctors and patients. Most of these problems can also be traced to the use of old medical terminologies originating from the difficult Chinese characters. The Korean medical community has been conducting a campaign to replace existing difficult medical terms with plain Korean, Hangul terms. Particularly, members of the board of medical education are expected to make active use of the new terms in their teaching fields, in writing research papers, and in their clinical practice.

Clinical Performance Assessment as a Model of Korean Medical Licensure Examination / 한국의학교육

BACKGROUND: Evaluation of clinical performance is an essential area for the students who are preparing their career as a medical doctor. However the clinical skills has neither been taught with balanced proportion nor adequately being assessed their abilities. Yet no significant studies on this issue has been reported in Korea so far. The present study was done as a part of preliminary study to seek a model that would be introduced clinical performance assessment in Korean Medical Licensure Examination system. Purpose: The objectives of this study is to develop items of clinical performance and the effective methods to carry out the clinical performance assessment in Korean Medical Licensure Examination system. METHODS: Primary list of clinical performances which was generated through discussion between researchers and medical experts has been distributed to the physicians of various levels. Six hundred ninety seven medical doctors including professors, family physicians, and public health doctors were asked to express their opinion by mail questionnaire. Final items were selected after the reaction of questionnaires and each item has been carefully studied its validity, achievability, and practicality. RESULTS: Thirty five items were selected among fifty one items presented according to the checked number of "essential" and "frequently useful". Seven items were added according to the higher rate of recommendation by open questionnaire. The forty two items were confirmed as a final list which the students should be expected to demonstrate prior to graduation from undergraduate medical school("exit objective"). The OSCE was performed without any serious logistic problems and both examinees and evaluators thought the experience positively. CONCLUSION: To look at the present environment and the readiness it is recommendable to apply the items of psychomotor skills at the beginning for Medical Licensure Examination. For that purpose various medical dolls, kits and subjects can be used.

An Experience of OSCE for Introducing Clinical Performance Assessment to Korean Medical Licensure Examination / 한국의학교육

BACKGROUND: Evaluation of clinical performance is an essential area of Medical Licensure Examination. Yet, clinical skills has been neither uniformly well taught nor adequately assessed. This study was done as a part of preliminary study to introduce clinical performance assessment to Korean Medical Licensure Examination. The goals of this study were to identify the potential logistic problems and to examine the feasibility of OSCE to Medical Licensure Examination. METHODS: 48 minutes long OSCE, which consist of eight 5-minute stations, was developed. The same examination was administered to students over a four-week period. RESULTS: Total 26 volunteer fourth-year medical students were tested. 11 students were examined at the first administration and the rest of them were evaluated four-week later. Cronbach alpha of the total stations was 0.52. Any big administration problems were not revealed. There was no significant total score difference between early examinee and later ones. Students evaluated the OSCE contents and process positively. CONCLUSION: To acquire more reliable and valid examination, we need to develop more objective checklist and evaluator and SP training.

Histochemical Study on the Expression of Heat Shock Protein 70 mRNA in Developing Mouse Brain / 대한해부학회지

Using in situ hybridization technique with digoxigenin-labelled riboprobe, study on the expression of hsp 70 mRNA in the developing mouse brain was performed. The results obtained are as follows; 1. In embryonic day 16 group, cells with strong reactivity to hsp70 mRNA were found in spinal cord. In neuroepithelial layer lining fourth ventricle and external granular layer of cerebellum, moderate reactivity was observed. But the reactivity was weak in the forebrain including cerebral cortex, diencephalon and olfactory bulb. 2. In embryonic day 18 group, the regional pattern of hsp70 mRNA expression was similar to that of embryonic day 16 group. In medulla oblongata, however, stronger reactivity was found in the embryonic day 18 group. 3. In postnatal day 0 mice group, cells with moderate or strong reactivity to hsp70 mRNA were found in the overall area of central nervous system, Especially, cells with moderate reactivity were found in the dentate gyrus of hippocampus, and the supragranular cortical plate and subplate neocortex. 4. In postnatal day 2 mice group, cells with moderate or strong reactivity to hsp70 mRNA were found in the same pattern as in postnatal day 0 group. Further differentiation of cerebral cortex and cerebellum was found. 5. Strong expression of hsp70 mRNA was found in the areas with high rate of cell division. In general, the area of expression moved to more rostral area in central nervous system as development proceeds. Above results suggest that hsp70 play an important role in the development and differentiation of central nervous system.

Comparative study of rat thyroid regeneration using PCNA and BrdU immunohistochemistry / 대한해부학회지

Cell proliferation index in the thyroid is regarded as an important marker for predicting the prognosis and for differential diagnosis of thyroid tumors. Among the methods for the detection of cell proliferation in histological sections, immunohistochemistry for PCNA and BrdU are the most preferable ones. In this study, we evaluated the regeneration process of the thyroid in the rat after surgical resection with special respect to the cell proliferation revealed by both PCNA and BrdU immunohistochemistry, and compared these two results. Rat thyroid was resected bilaterally, about 50~60% of the total lobe in volume, and the tissues were obtained 1, 2, 3, 4, 5, and 7 days after operation, immunohistochemistry was done, and positive and negative cells were counted. The regeneration pattern reflected by cell proliferation was basically same in both PCNA and BrdU immunohistochemistry, except that the positive ratio for PCNA was 4~6 fold higher than that for BrdU in general. In the control thyroid, positive cells were rare. However, the ratio of positive cells increased immediately after the operation, on day 1, and reached at its peak on day 2. The high ratio sustained until day 4, after which the ratio declined abruptly. Through the experimental days, positive cells were more crowded in the area adjacent to the resection plane than elsewhere, suggesting that the areas are more active regenerating focus. Although the pattern of proliferation was same both in PCNA and BrdU immunostaining in terms of time and localization, BrdU staining was easier to read and seeded to reflect cell prolifer-ations more specifically than PCNA staining.

Past, Present and Future of KSME / 한국의학교육

No abstract available.

Learning Effects of Computer-aided Anatomy Laboratory / 한국의학교육

To determine whether computer aided sessions can effectively replace some of the labor intensive laboratories in human gross anatomy, second-year medical students at the College of Medicine, Chung-Ang University were randomly assigned to either a traditional cadaver-dissection or self-learning using intensive computer programs of gross anatomy covering the same materials. After finishing the six-week anatomy course covering the upper and lower extremities, two groups of students were tested in written and practical examinations. Even though they were tested on an actual cadaver, in a statistical analysis, the performance of thirty students in the computer-lab were not significantly different from sixty-five students group in the dissecting lab. It strongly suggestes that part of traditional gross anatomy laboratory can be replaced to a digitalized laboratory.

Expression of Guanine Deaminase in the Developing Rat Brain / 대한해부학회지

Guanine aminohydrolase (GAH; Guanine deaminase, EC 3.5.4.3) is an enzyme that has a role in purine catabolism. This enzyme produces xanthine and ammonia by hydrolysis of guanine, and xanthine is further degraded to uric acid and hydrogen peroxide by another enzyme, xanthine oxidase. Most of the enzymes involved in purine catabolism have been studied for their biological functions, physiological roles and amino acid sequences, and biochemical activity of GAH is known to be detected in various organs such as liver, kidney, small intestine and brain. Its activity is also known to be changed during brain development. In this study, we hoped to reveal expression pattern of GAH in developing rat brain by western blotting and immunohistochemistry. In western blotting, GAH immunoreactivity was not detected on 14-, 16- and 18-days-old fetal rat brains. Its reactivity was first detected from 20-days-old fetal rat brain and highly increased after birth. And it was maintained at steady level from 2 weeks after birth. In immunohistochemistry, no positive cells were found on 14- and 16-days-old fetal rat brain sections. A few GAH-immunoreactive cells appeared from 18-days-old fetal rat brain and they were localized at olfactory bulb, cerebral cortex, midbrain, pons and medulla. The 20-days-old fetal rat brain also showed immunoreactive cells at hippocampus and the staining intensity was still weak. Postnatal 2-days-old rat brain also showed immunoreactive cells at basal ganglia and the number of positive cells and staining intensity were increased. Thereafter, immunoreactivity appeared on many neuronal cells around various areas in the brain and nerve fibers also showed reactivity on postnatal brains. The number of positive cells decreased from 1 week after birth and a few positive cells were observed on olfactory bulb and cerebellum from 2 weeks after birth. In mature brain most of GAH were localized on nerve fibers and few positive cells could be found on olfatory bulb only. From these, we can suspect that GAH may have some functional relationship with nerve fibers.

Immunocytochemical study on the distribution of NOS-immunoreactive neurons in the cerebral cortex of aged rats / 대한해부학회지

Nitric oxide (NO) involvement has been demonstrated in mechanisms of synaptic plasticity, particularly in hippocampal long-term potentiation, a mechanism that underlies certain forms of learning and memory. Further, NO has been shown to regulate various neurotransmitters which play an important role in learning and memory. Several findings suggest that NO production may be decreased in the aged rat. Changes in the nNOS-containing neurons with aging were demonstrated by immunocytochemistry and in situ hybridization. NOS-immunoreactive cells in aged rats were present in all cortical areas and the hippocampus, and the pattern of distribution was similar to that of the control group. The number of NOS-immunoreactive cells in the cerebral cortex was significantly decreased in the aged rats, but the extent of changes was variable in each area, and ranged from mild decrease (50%). Severely decreased areas were the cingulate cortex, parietal cortex area 1, temporal cortex area 1, 2, 3, medial part of occipital cortex area 2, monocular and binocular part of occipital cortex area 1, entorhinal cortex, hippocampus proper, dentate gyrus and subiculum. Moderately decreased areas (30~50%) were frontal cortex area 1, 2, 3, parietal cortex area 2, forelimb, hindlimb, lateral part of occipital cortex area 2. Slightly decreased area was insular cortex. Morphologically, the number of dendritic branches seemed to be decreased in aged group and the length of dendrites of NOS-IR neurons showed a tendency to shorten. These results indicate the involvement of neuronal system containing NOS in the aging brain, and provide the first morphological evidence for the loss of NOS neurons in the cerebral cortex of the aged rats by immunocytochemistry. Further multidisciplinary investigations involving normal aging and neurodegenerative disease such as Alzheimer's disease are needed to clarify the importance of nitric oxide changes in the cerebral cortex with aging.

Spatial and temporal expression patterns of apoptosis-related genes in rat spinal cord during normal aging / 대한해부학회지

The pattern of distribution in rat spinal cord and changing pattern during normal aging of c-Fos, Bcl-2, Bax, and p53 expression were investigated by immunohistochemical staining. Male Sprague-Dawley rats at the age of one week, five months, and two years were studied. C-Fos immunoreactivity was observed diffusely in gray matters in neonatal rats, preferentially located in deep dorsal horn and around central canal. Compared with those of neonatal rats, immunoreactive cells decreased prominently in adult rats. In aged rats, these cells were not seen in any segments. In a transverse section, spatial expression of Bcl-2 and Bax proteins showed a diffuse distribution pattern with immunore-activity more prominent in the anterior horn. Continuing expression of these proteins was shown in each age group. In adult rats, Bcl-2 immunoreactivity was decreased drastically compared to that of neonatal rats. The immunoreactivity was higher in aged than in adult rats, but the number of immunoreactive cells was not different between aged and neonatal rats. The number of Bax-immunoreactive cells was greater in adult than in neonatal rats; in aged rats, it was similar with that of adult rats. The spinal cords of neonatal rats were not p53-immunoreactive, though p53-positive cells were detected in all segments of adult spinal cord. P53-positive cells were stained along the cellular margin, with a pale central portion. The pattern of p53 immunoreactivity in adult and aged rats was similar; the number of p53-positive cells, however, was higher in aged rats than in adult. In conclusion, we demonstrated that the expression patterns of c-Fos, Bcl-2, Bax, and p53 proteins in rat spinal cord change during normal aging for the first time.

Carbonic anhydrase II immunostaining in the cerebellum of postnatal mice / 대한해부학회지

The carbonic anhydrase II (CA-II) is specifically expressed in oligodendrocytes, the cells responsible for myelination in the central nervous system. However no direct evidence on relationship between myelin formation and CA-II immunoreactivity has been described. The aims of these studies are to investigate the relationship between CA-II and myelination during cerebellar development of mouse. Myelin staining was found on postnatal (P) 14, and its intensity increased in proportion to developmental age. CA-II positive oligodendrocytes were observed in the white matter of cerebellum on P 14 day. CA-II positive oligoden-drocytes also occured in the granular layer and Purkinje cell layers in the later stage of dvelopment. The parallel development in the CA-II expression and myelination during development suggests that CA-II in oligoendrocyte play a role to myelination.

Observation of Endothelial Cell Differentiation by 3D Cell culture system: Angiogenesis inhibition of Thrombospondin-1 / 대한해부학회지

Angiogenesis plays a fundamental role in development of circulation system, reorganization of reproductive system, wound healing. Pathological angiogenesis is deeply involved in a variety of diseases, particularly solid tumor growth and metastasis. However, it is not easy to study the mechanism of angiogenesis because endothelial cells proceed complex differentiation by interaction with extracellular matrix proteins and growth factors. However, human umbilical vein endothelial cells (HUVEC) form polygonal networks of capillary-like tubes in 3D Matrigel cultures. Differentiation of endothelial cells will be observed accurately by application of videomicroscopy. Thrombospondin-1 is secreted by a wide variety of cells including endothelial cells and is incorporated into their matrix. Thrombospondin-1 can modulate differentiation of endothelial cells by increasing cell-cell interactions as well as cell-substrate interactions. The current study was undertaken to determine which mechanism is involved in inhibition of angiogenesis by Thrombospondin-1. They was secreted from HUVEC during the process of angiogenesis in 3D Matrigel culture. When applied to endothelial cells attachment to the surface of Matrigel was not decreased, but spreading was decreased. In addition, bigger clusters was formed by enhancement of cell to cell binding by Thrombospondin-1. They inhibit cord and tube formation of HUVEC by inhibition of migration. These results suggest that Thrombospondin-1 inhibits angiogenesis by blocking differentiation of endothelial cells to motile phenotype in 3D Matrigel culture.

Status of Cadaver Collection of Medical Colleges for Their Anatomy Education in Korea / 체질인류학회지

This study eximaned the status of cadaver collection of medical colleges in Korea for their anatomy education during the last thirty years. The total collected number of cadavers during the first decade (1971 ~1980) were 1, 182. The numbers increased year gradually and it showed 1, 771 during the second decade (1981 ~1990). Thereafter the collection rate dropped suddenly to 607 during the period of 1991 ~1996. Compare to the total number of medical colleges (from 14 to 41 schools) and medical students (from 1,300 to 3,300 students) during the examined period, the ratios of medical students joining to dissection per cadaver were getting worse until the donation of cadavers become popular after 1994. In 1995 ~1996, 83.2% of total collected cadavers in Korea were available from donation, while the donation rate in 1989 ~1990 was only 7.5%. We have been tried to collect donated cadavers for richly available cadavers and to prepare that combination of plastination materials and models with advanced tools for visualization provides the look and feel of real dissection.

The necessary revision of plastic surgical terminology in Korea

Majority of the medical terminology we are using in Korea originated primarily from the Japanese based on the Chinese characters. Even though we are sharing the common Chinese characters there are significant differences in pronounciation and meaning which may create tremendeous confusion in medical terminology particuIary in plastic surgery field if one simply adapting other country's teminology without proper screening and refining process, which might encourage medical practitioner to use English in their daily clinical activity. The authors carried out a review of the medical terminology in the field of plastic surgery particularly based on clinical applicability. We have listed problems caused by simple adaptation of foreign medical terminology not only in conversational but also in written terminology with its a critique as a viewpoint of native speaker. We have discussed the justification that we have to review the medical terminology to improve our Korean scientific words in plastic surgery. We have also proposed the general direction and principles in revising medical terminology more systematically in order to get an effective results. Finally we have listed several examples to correct the terms which have widely been used erroneously in plastic surgery.

Optimal Number of Blood Cultures and Volume of Blood Needed to Detect Bacteremia in Children

PURPOSE: We compared pathogen recovery rates by obtaining two blood cultures instead of one blood culture containing 1ml and collecting a larger volume, 1 to 3ml. METHODS: Total of 750 blood specimens from 250 patients with fever, a temperature higher than 39degrees C and suspected bacteremia were obtained. Each patient had two samples of blood, A (1ml) and B (4ml), obtained at 30-minute interval from separate sites of extremities and B was divided into B1 (1ml) and B2 (3ml). Each sample was inoculated into aerobic culture media. Patients were excluded if two samples of blood were not obtained or if the isolate represented a contaminant. RESULTS: A pathogen was isolated in 19 (7.6%) of 250 patients and 37 (4.9%) of 750 specimens. In 7 patients, the pathogen was isolated with all the culture methods and in 12 patients, one or more of the cultures yielded no growth. The pathogen recovery rates were 53% (10/19) in A and B1, 89% (17/19) in B2 and 68% (13/19) in A+B1. No difference was detected between A or B1 and A+B1 (P>0.05) and the pathogen recovery rate for B2 was significantly greater than that for A or B1 (P<0.05), but no significant differences were found in pathogen recovery when B2 was compared with A+B1. CONCLUSION: Increasing volume of blood from 1 to 3ml inoculated into blood culture bottles improves detection of bacteremia in pediatric patients and spares patients the cost and pain of an additional venipuncture.

Optimal Number of Blood Cultures and Volume of Blood Needed to Detect Bacteremia in Children

PURPOSE: We compared pathogen recovery rates by obtaining two blood cultures instead of one blood culture containing 1ml and collecting a larger volume, 1 to 3ml. METHODS: Total of 750 blood specimens from 250 patients with fever, a temperature higher than 39degrees C and suspected bacteremia were obtained. Each patient had two samples of blood, A (1ml) and B (4ml), obtained at 30-minute interval from separate sites of extremities and B was divided into B1 (1ml) and B2 (3ml). Each sample was inoculated into aerobic culture media. Patients were excluded if two samples of blood were not obtained or if the isolate represented a contaminant. RESULTS: A pathogen was isolated in 19 (7.6%) of 250 patients and 37 (4.9%) of 750 specimens. In 7 patients, the pathogen was isolated with all the culture methods and in 12 patients, one or more of the cultures yielded no growth. The pathogen recovery rates were 53% (10/19) in A and B1, 89% (17/19) in B2 and 68% (13/19) in A+B1. No difference was detected between A or B1 and A+B1 (P>0.05) and the pathogen recovery rate for B2 was significantly greater than that for A or B1 (P<0.05), but no significant differences were found in pathogen recovery when B2 was compared with A+B1. CONCLUSION: Increasing volume of blood from 1 to 3ml inoculated into blood culture bottles improves detection of bacteremia in pediatric patients and spares patients the cost and pain of an additional venipuncture.

Immunohistochemical Study on the Nitric Oxide Synthase in the Developing Rat Brain / 대한해부학회지

Nitric oxide(NO) is thought to play an important role in development and plasticity of brain. In this study, we aimed to examine the expression of neuronal NOS and NADPH-diaphorase (NADPH-d) activity in the developing rat brain. The results show that there is a great variation in the time of appearance of the earliest NOS containing cells depending on their location: At the 15th embryonic day weakly stained cells were present in caudate-putamen, and neurons in the sensory trigeminal nucleus and the solitary nucleus displayed an intense staining. The NOS neurons in orbital neocortex, bed nucleus of stria terminalis, paraventricular hypothalamic nucleus, lateral hypothalamic area and mammillary body appeared first at the 18th embryonic day. The supraoptic nucleus and superior and inferior colliculi also weakly labeled at the 18th embryonic day, At the loth embryonic day, positive cells appeared in horizontal limb of diagonal band, anterior olfactory nucleus and parafascicular thalamic nucleus. In the cerebellum, weak NOS staining was present in fibers and cells situated below Purkinje cert layer. The Purkinje cell layer displayed a weak, rather diffuse activity throughout the cerebellum at postnatal day 0. At the 4th postnatal day. the reaction product in the Purkinje cell layer became more distinct. At the 10th postnatal day, the inner part of molecular layer became populated by NOS positive basket cells, and the reaction products on the Purkinje cells began to disappear. The present results showed that NOS in the rat brain is expressed in different populations of neurons at different stages of development. This expression pattern of NOS suggests that NO may play a role in the developmental remodelling of the mammalian brain.